Self-harm behavior and no-suicide contracting in psychiatric inpatient settings

Although negotiation of no-suicide contracts is common practice, research r egarding the outcomes of contracting is inadequate, The purpose of this ret rospective review of medical records was to examine how no-suicide contract ing affected the likelihood of self-harm behavior in psychiatric inpatient settings. Thirty-one patients (4.8%) engaged in self-harm behaviors represe nting 2.64% of all patients admitted to both study settings during the 61/2 -month period from which data were collected. Approximately half of those p atients expressed suicidal intent. Logistic regression analysis suggested t hat patients with no-suicide contracts and with higher levels of restrictio n had a significantly higher likelihood of self-harm behavior (OR = 7.43 an d 2.47, respectively, p = .005), Consistency of nursing assignment is likel y associated with a lower probability of self-harm (OR = .07) but p = .068 when this variable was included in the model, Prevention of self-harm behav iors by the use of no-suicide contracting is not shown. Negotiation of a co ntract is likely a reflection of staff assessment that the patient was at h igh risk for suicide. These findings confirm the need for thorough, ongoing assessment of suicidal risk, whether or not a patient has agreed to a no-s uicide contract. Copyright (C) 2001 by W,B, Saunders Company.